2 型糖尿病患者轻度认知功能障碍相关危险因素研究

目的探讨2型糖尿病（T2DM）患者轻度认知功能障碍（MCI）相关危险因素，为早期诊断、早期干预提供依据。方法选用蒙特利尔认知评估（MoCA）北京版量表作为认知功能的测评工具，选择T2DM并发MCI患者54例（MCI组）和无MCI的T2DM患者66例（NC组）。采集患者一般资料，检测空腹血糖（FPG）、糖化血红蛋白（HbA1c）、C肽、收缩压（SBP）、舒张压（DBP）、三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C），超声探查颈动脉双侧内膜中层厚度（IMT），其中IMT较大一侧的数值定义为最大IMT值。采用成组t检验和多重线性逐步回归进行统计分析。结果MCI组患者FPG、HbA1c、C肽水平、高血压病程、糖尿病痛程、SBP、最大IMT值与NC组比较，差异均有统计学意义（P〈0．05）；而两组患者年龄、性别构成、高血压病史、体质量指数、腰臀比、DBP、TG、TC、LDL．C、HDL．C比较。差异均无统计学意义（P〉0．05）。患者的高血压病程、糖尿病病程、最大IMT、SBP、FPG、HbA1c与MoCA量表评分呈负相关（P〈0．05）；C肽水平与MoCA量表评分呈正相关（r=0．353，P=0．000）。多因素回归分析显示，最大IMT（B=-2．878，P=0．001）、HbA1c（B=-0．410，P=0．001）、C肽水平（B=1．281，P=0．001）是MoCA量表评分的独立危险因素（P〈0．01）。结论FPG、HbA1c、C肽水平、SBP、高血压病程、糖尿病病程、最大IMT可能是T2DM患者发生MCI的危险因素，临床应采取早期干预措施。

Study on risk factors of mild cognitive impairment in patients with T2DM

Objective To investigate the risk factors of mild cognitive impairment（MCI） in patients with type 2 diabetes mellitus （T2DM） and provide the basis for early diagnosis and early intervention. Methods Montreal Cognitive Assessment（MoCA） （the scale of Beijing＇s version） was used as a cognitive function assessment tool. 54 patients with MCI and T2DM （MCI group） and 66 patients with T2DM but not MCI（NC group） were selected. The general data of the patients were collected to detect fasting plasma glucose （FPG）, Hemoglobin Alc （HbAlc）, peptide C, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, triglyceride （ TG ）, total choleslerol （TC）, high-density lipoprotein cholesterol （ HDL-C ）,low density lipoprotein cholesterol （LDL-C） and ultrasound bilateral carotid intima-media thickness （IMT）, and the larger value of IMT on one side was defined as the maximun IMT. Group t test and multiple linear stepwise regression were used for statistical analysis. Results The difference was statistically significant between the MCI group and NC group on FPG, HbAlc,level of peptide C, course of high blood pressure （HBP）, course of D2TM,SBP,maximum value of IMT（P〈0.05） ,while there was no statistically significant differences between the two groups on age, sex composition, the history of hypertension, body mass index （BMI）, waist-hip ratio （WHR）, DBP, TG, TC, LDL-C and HDL-C （P〉0.05）. MoCA scores were negatively correlated with course of HBP, course of T2DM, maximum value of IMT, SBP, FPG and HbAlc （P〈0.05）. MoCA scores were positively correlated with level of peptide C （r=0.353, P=0.000）. Multiple factors regression analysis showed that maximum IMT（B=-2.878,P=0.001 ） ,HbAlc （B=-0.410,P=0.001） ,level of peptide C （B=1.281, P=0.001） were independent risk factors for MoCA rating scores with statistically significant difference（P〈0.01）. Conclusion FPG, HbAlc ,level of peptide C ,SBP,course of HBP,course of T2DM and maximum value of IMT are risk factors for MCI in patients with T2DM, and early intervention measures should should be taken clinically.